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Re: That amazes me » UgottaHaveHope

Posted by Honore on May 7, 2007, at 19:38:00

In reply to Re: That amazes me » Honore, posted by UgottaHaveHope on May 5, 2007, at 14:45:28

Hi, Michael (and Kaye).

I thought I would try to describe why I found Emsam better for anxiety at 12 mg than 6 mg and what other meds I've used with it.

I've had a pretty severe chronic form of atypical depression for my whole life (since adolescence). I've also experienced radical worsenings of it, at intervals of pressure to perform, or under other stress or when in destructive relationships.

I never took any ADs before I went to a pdoc in my city about five years ago, at which point he recommended an Maoi (which is something he's very experienced with and has used, despite their unpopularity).

I had been taking provigil before that, which I had gotten at a foreign pharmacy, for my own use-- because I had no energy or motivation and was trying to help myself do some work.

So I used Parnate with the provigil, and also xanax, because he observed that I had pretty severe anxiety attacks also.

I had to stop the Parnate, because of a rare side effect, after about three and a half years.

When I started Emsam, in May 2006, , the depression had gotten pretty bad, so I was starting from a bad state-- although I hadn't been suicidal since prior to the Parnate. So I was pretty depressed when I started and also not doing much work, and avoiding contact with other people entirely.

I did feel what I would have called anxiety on the Emsam, but I also simultaneously found that I was more able to get through or past it. So I would have an anxiety attack, and then instead of becoming avoidant, I would still want to try going out, and would feel much more able to meet people, or do things.

I should point out, I'm also in therapy and I feel that that interacted with the Emsam in a very helpful way.

At one point, I was using 18 mg for 12 hours, rather than 9 mg for 24, because of sleep problems, and I noticed that I was starting to have a sense of internal agitation-- very strong repetitive or obsessive negative thoughts about things that had happened or about my surroundings (if I was outside). But it was different from anxiety-- it was heightened, but it was also almost like a very aggressive feedback loop in my head that was pushing everything else aside and that I couldn't relieve.

So I reduced the amount to 12 mg/18 hours and this agitation completely remitted. I did have some level of anxiety, which decreased over time. But even when this lesser agitation was palpable, I found that there was some sort of compensating greater openness and willingness to try social things., It wasn't a huge change, but it was progressive, so that by the end of the summer, I was, with difficulty, doing things I hadn't been able to do for years.

I think, also, that I was somewhat less likely to become totally discouraged and was more able to think in a hopeful way about solutions to things that had come up that I was upset about. I would initally get upset, but somehow, I found that the Emsam opened up some space for me to think more about possible ways of handling things, and to move away from the panic--and also not to return to the fearful thoughts, again and again, but to stick with the idea that I could handle the problem.

And as I say this was rather modest at the beginning-- although it was noticeable after a few weeks, but it became much more noticeable during the late summer and early fall.

In Sept., I had to stop the Emsam because of another reaction to another med.

I resumed the Emsam in December 2006.

This first time around, I was taking Emsam, provigil, adderall and/or ritalin often but not all the time, xanax, at times, sometimes everyday and other times less often, but fairly frequently, and about 12 .5 mg seroquel for sleep. I found 12 mg to be a much more effective dose, because it accentuated the positive, without increasing my anxiety-- so the openness and ability to handle things seemed much stronger, and the Emsam-specific anxiety had seemed, over time, to have abated, possibly from accommodation-- as had the insomnia. I still did have insomnia-- but I always have had that.

So I guess I'd say there's accommodation that makes the anxiety much less problematic.

Activation doesn't always mean anxiety for me, though, because I have such reduced energy and motivation, with a lot of anxiety. I don't know how that would work for you.

For example, provigil has given me energy, but has never made me anxious. Adderall does involve some anxiety, but I don't find that ritalin does.

Sorry this is so long-- I do think everyone is so different, sometimes it's hard to answer questions abstractly. The second time around has been much better, but it's kind of different, and maybe this answers the main question.

Honore


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poster:Honore thread:755423
URL: http://www.dr-bob.org/babble/20070502/msgs/756621.html